It hurts “down there” – Postpartum Wound Care and Healing

It hurts “down there” – Postpartum Wound Care and Healing

Congrats you had your baby, but no one told you that things might be a little swollen and sore in your vagina or vulva – ok maybe a LOT sore. Every few days you should notice that the pain is slowly improving, but it may take several weeks to feel better.

Here are some suggestions on how to best help you heal.

After a Vaginal Delivery

This can vary depending on the degree of tear you may have had or not had at all. Some have “rug burn” that needed no stitches, some have 1 or 2 stiches, while others may have had several stitches or maybe an extensive degree of tearing that actually need a minor surgery to fix. Needless to say it can take several weeks to heal. It is important to keep the area clean to prevent infection and encourage healing. Lochia is the normal vaginal discharge that occurs after having a baby; this can sometimes be confused with abnormal bleeding or infection. Initially lochia is bright red blood which changes to a brown then yellow and finally to either a white or clear mucous. If you are unsure if it is normal, ask your doctor.

Some things you can do to keep comfortable and help the healing process include the following:

Find comfortable seating; sometimes a padded pillow or ring/donut pillow can help

Use cold compresses (or a frozen bag of peas) in the first 24hrs. Please ensure that this is not skin to skin but separated from direct contact with skin by a barrier such as a towel.

Use the peri-bottle (little squirt bottle) they provided you in the hospital to clean the area with warm water while you go pee and after going to the washroom. Toilet paper is not necessary except for bowel movements (even then you can use a cloth instead).

Use a clean pad or washcloth instead of toilet paper to pat the area dry. Avoid rubbing or any motion that causes discomfort. Some women find putting the pad over the wound when bearing down for a bowel movement is helpful.

Use either a sitz bath (small little tub that fits on the toilet) after every bowel movement or have a bath in warm water 1-2 times per day if possible. This is hard to do with the lack of sleep and constant feeding your newborn demands of your time, but try as often as you can to squeeze it in as it can speed up healing.

Take pain medications as instructed. Often acetaminophen and ibuprofen are prescribed together. They will not harm your baby if breastfeeding. There are a few cases when they are contraindicated. Ask your doctor if you have any concerns about the medications they have provided you.

Ensure your bowel movements are soft. There are several safe stool softeners you can take, but make sure you are eating a high fibre diet and drinking enough water to help keep the stools soft as well.

Cold pads with witch hazel can provide some relief. You can buy special wipes that have the witch hazel already in them or you can pre-soak some pads and put them in the fridge to use as needed.

Do not use tampons as these can cause an infection.

In the long term, women can struggle with incontinence of urine due to weakness of the muscles in the pelvic floor. Simple Kegel exercises done several times per day (3 sets of 10 repetitions daily) can help build these muscles back up very well. You need to wait a few weeks before starting them. There are several great pelvic floor physiotherapists in Ottawa that can help ensure you are doing them correctly and offer other techniques to strengthen your pelvic floor muscles.

Until your perineal pain has resolved (usually about 4 to 6 weeks) it is best to avoid sex.

After a C-section

You might still have some vaginal discomfort if you were labouring or got to the pushing stage but hopefully no tears. If so, see above which also applies for discomfort. The staples/sutures on your stomach are often removed in the first 2-3 days. Little strips of tape are then applied. The edges of these strips will start to curl up and then eventually fall off. It is important to keep the area of the wound clean with soap and water. Do not rub but pat to dry the area.

See your doctor if any of the following occur:

Worse swelling, redness or heat of either the area of the tear or your abdominal wound

Increasing pain in the wound area (abdomen or vagina/vulva)

Smelly or pus like vaginal discharge

Bleeding increases and/or changing your pad more than every 2 hours or having large blood clots

Unable to urinate or more frequent, painful urination

Difficulty or unable to have bowel movements

Fever or feeling unwell

Your abdominal incision has pus, increasing redness or pain, or appears to be opening up.